WRITE UPS - MISCELLANEOUS: (OB) - MTP in Medical Disorders in Pregnancy


MTP in medical disorders in pregnancy is to be viewed from two angles:

1) Those medical disorders where continuing this pregnancy would prove a grave risk to the life of the mother. In these situations. The medical disorders itself becomes an indication for MTP.

2) Situations where MTP has to be done and a medical disorders is found incidentally, herein, the extra care that is required to be taken, especially due to this medical disorders in pregnancy, is to be considered.

  MTP and Hypertensive Disorders of Pregnancy: -

This area in obstetrics is admittedly one where clinicians face a big dilemma. In clinical situations where BP of a woman is rising in spite of a rational and correct treatment, termination of pregnancy is considered Pre-eclampsia remote from term is now acknowledged as a distinct entity. It has strong immunological basis. In absence of any signs of abetting of its fury and development of complications, MTP becomes a natural choice. However, this stage comes usually in late second trimester. Second trimester termination with ethacridine lactate usually doses not give any problems and can be easily carried out. In such immunological problems of pregnancy even eclampsia can occur. Therefore, it is not without reasons to consider an immediate MTP if eclampsia has occurred.

On the other side, a woman may solicit MTP for some other reasons and is incidentally found to be hypertensive. It is likely that she may be a known hypertensive and is now soliciting MTP for some other cause. It is always to be stressed to the patient that hypertension worsens with increasing age. It is therefore advisable to continue this pregnancy if reasons for MTP are not very compelling. In spite of all of these attempts, if MTP has to be done, then BP has to be taken in control with suitable antihypertensives. Once this is achieved, first- trimester MTP under short general anesthesia, can be safely carried out. A well-controlled BP does not go haywire during the procedure and even postoperatively. Most physicians advice that the morning does of antihypertensives must to be taken albeit with small sips of waters. In cases where BP goes alarmingly high postoperatively, sublingual dose of drugs like nifedipine 5 mg becomes a good treatment method.

MTP in Cardiac Disorders in Pregnancy: -

Coarctation of aorta has been much asked and answered as an absolute indication of MTP amongst these conditions. Though discussed many a times, an average clinician might hardly see one such case in his or her career. This is not to undermine its dangers. Agreeably, it can produce a dissection, and some cases of spontaneous rupture have been reported. On the other hand, many physicians have frantically referred patients with common valvular heart disease to obstetricians for MTP. It is with a sense of satisfaction one notes that on most occasions, obstetricians have correctly refused such terminations. Therefore, the bottom line is valvular heart diseases to be per se are no indication for termination of pregnancy. In fact MTP can prove more stressful and decompensation for the mother than pregnancy and childbirth.

An often –debated issue is worth touching here. Valvular heart disease with incorrigible cardiac failure-these are those rare situations where with advancing pregnancy and in spite of correct treatment, cardiac failure fails to correct itself. Some authorities are advocating that the added stress of pregnancy will worsen the cardiac condition. It can even prove fatal. Keeping the risk of anesthesia in such cases in mind, many workers suggest that these MTPs should be carried out under Para cervical block with skilled anesthetists remaining present as standby. It is very difficult to make a broad policy judgment in this situation. However, the best policy would be to individualize such cases and handle them with due caution.

The other aspect of this is where a subject solicits MTP and is incidentally found to have a cardiac disease. It is noteworthy that on most instances these are valvular heart disease. If the subject can be convinced, it is advisable to continue this pregnancy. Risks of termination require to be explained in case MTP becomes a must. A through cardiac respiratory assessment will help in foreseeing problems that may develop in due course. A rotational antibiotic umbrella must cover the procedure to prevent development of subsequent scary complications like endocarditis.

MTP in Diabetes in Pregnancy: -

Per-sé diabetes is not an indication for MTP. Poorly controlled diabetes leading to congenital malformations in the baby is a valid indication for pregnancy termination. It is nowadays believed that even conception could occur in a controlled diabetic state. In absence of good diabetic control, obstetric complications can occur. However, these are to be handled by proper adjustments of doses of antidiabetics. MTP is not the solution to the problem. Like cardiac disease many times obstetricians do get references from their physician friends soliciting MTP for diabetic mothers, Most of the times obstetricians do not agree to do so and this is admittedly a wise policy.

The other angle is of soliciting MTP for some other indication and the subject is found to be diabetic on a routine preoperative assessment. It need not be overstressed that such patients should be counseled for continuing pregnancy. This is because diabetes is known to worsen with increasing age. If the patient in concern is desirous of a child subsequently, in all wisdom, if reasons for MTP are not very compelling, this pregnancy should be continued. Needless to add, proper control of diabetes should be instituted now.  

However, if MTP has to be performed in a diabetic subject than the situation becomes demanding. A preoperative control of diabetes has to be achieved. Proper maintenance of euglycemia state on the day of the procedure will require more than a trifle attention. It is advisable to have the subject a little toward the hyperglycemic side. Hypoglycemia can go undetected and can prove dangerous. Postoperatively, the woman has a higher chance of going in hypoglycemia. This is because the time elapsed from her taking meals the previous night to that at present is increasing. It is advisable to supplement parenteral glucose adequately in such conditions. Some workers have advised a urinary glucose monitoring for management of such situation. However, blood glucose estimation is more precise. Susceptibility to infections in postoperative phase in diabetics is known. A proper and rational cover with antibiotics is mandatory.

MTP in Hematological Problems in Pregnancy: -

Anemia is the most common hematological disorder in pregnancy. It is quite logical to note that nutritional anemias are no indication for termination of pregnancy. However, the non-nutritional anemias do come up for termination in clinical practice.

Subjects testing positive for thalassemia in both partners may solicit a termination of pregnancy. In modern obstetric practice, CVB or cordocentesis for detecting thalassemia in the unborn fetus is well known. A pregnancy in which the fetus is affected by thalassemia major may be considered for termination. This holds true for parents having a fetus with sickle cell disease, as well.

MTP after proper counseling may be required in these cases. These mothers who are invariably thalassemia minors may be having anemia. Their hemoglobin levels titer around 8 gm percent. In such a situation, a proper oxygenation intensive monitoring of SPO2 and other vital parameters and prevention of cardiac overload, tests the anesthetist. However, postoperatively these subjects remain stable.

By and large second trimester MTP in such subjects with ethacridine lactate is done. Excessive blood loss after the abortion should be actively prevented. If its still occurs, the obstetricians have to be very active and treat it enthusiastically. However, it need not be misconstrued that these subjects are more likely to develop post-abortal bleeding. Her chances of this bleeding are same as in general population.

Subjects who solicit MTP for other indications, and are found anemic, are usually advised to wait till her anemia is corrected.  Such a policy is wise and recommended.

MTP in Jaundice in Pregnancy: -

Probably nowhere has the role of pregnancy termination been poorly understood by our colleagues in internal medicine than in jaundice. In modern obstetrics, there is no role of MTP for jaundice in pregnancy. In fact MTP can worsen the maternal condition and can take her to complications, much more speedily. Usually hepatitis is the cause of jaundice in an average obstetric practice. This is known to worsen consistently following on MTP. It is also true that mothers so suffering are very likely to develop complications like post procedural bleeding, which can even prove fatal. It is therefore recommended, not to terminate pregnancies in such conditions, however, on nature taking it sown course, the pregnancy is spontaneously aborted, then it should be managed as such.

No obstetrician will ever do an MTP in a woman soliciting the same for some other reasons and is incidentally found to be jaundiced. Such a decision is commendable and appreciated.

MTP in Respiratory Disease: -

None of the respiratory diseases are an indication of MTP in modern obstetrics. However those using prostaglandins for routine MTPS are advised to rule out bronchial asthma before the procedure. 

Anesthesia risk in women having respiratory problems is well known. Besides a good preoperative control, a vigilant intraoperative monitoring is also vital. However, it is advisable not to take up mothers for MTP in presence of active respiratory infections including upper respiratory infections. Treatment is usually very effective and postponement if at all, is at the most for a fortnight.


Any mother who is pregnant can have a medical disorder in pregnancy. Any of such mothers can solicit an MTP. Wisdom lies in correctly understanding the diseases, its problems, and the treatment. Once they are understood, decision making for MTP is not difficult. 



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